Subclinical nutritional deficiency in treated coeliac disease and nutritional content of the gluten free diet

Patients with coeliac disease are started on a gluten free diet at the time of diagnosis, but after a varying period of follow-up are often discharged from outpatient and dietary follow-up. We have studied the nutritional status and dietary intake of 54 patients with treated coeliac disease diagnosed in adult life. Each patient was paired with a healthy age and sex matched control. There was no difference in height in patients compared to controls, but a greater proportion of patients (15%) than controls (4%) had weight below the UK population lower 5th percentile (x2 test P<0.05). Triceps skinfold thickness was 102% of age and sex matched mean reference values, but mid-arm circumference and arm muscle circumference were below reference mean values (93.1% and 91.5% of reference values, respectively). Haemoglobin, mean corpuscular volume, red cell folate and 25 hydroxyvitamin D were all in the normal range. A strict gluten free diet was followed by 78% of patients; 22% had occasional gluten intake. Seventy-four per cent considered that they had reduced their intake of bread since commencing a gluten free diet. In 48% of patients, average daily intake of energy was less than the estimated average requirement, and in more than one-third of patients the intake of iron, copper, magnesium, retinol and folic acid was less than the relevant reference nutrient intake (RNI). In more than 10% of patients, average daily intake of calcium, zinc or vitamin B6 was less than the RNI. Vitamin D intake was lower than the RNI in four of five patients older than 65 years.